Apparatus and method for maintaining image quality while minimizing x-ray dosage of a patient

ABSTRACT

A system including initialization, imaging, alignment, processing, and setting modules. The initialization module obtains patient parameters for a patient and procedure and surgeon parameters. The initialization module selects first settings for an x-ray source based on the patient, procedure, and surgeon parameters. The image module obtains a first sample set of images of a region-of-interest of the patient and a master sample set of images. The first sample set was acquired as a result of the x-ray source operating according to the first settings. The alignment module aligns the first sample set to the master sample set. The processing module processes pixel data corresponding to a result of the alignment based on a pixel parameter or one of the patient parameters. The setting module adjusts the first settings to provide updated settings. X-ray dosage associated with the updated settings is less than x-ray dosage associated with the first settings.

CROSS-REFERENCE TO RELATED APPLICATIONS

The application is a continuation of U.S. patent application Ser. No.14/925,440 filed on Oct. 28, 2015. The entire disclosure of the aboveapplication is incorporated herein by reference.

FIELD

The present disclosure relates to x-ray imaging systems, and moreparticularly to control systems for controlling x-ray dosage of an x-rayscanner.

BACKGROUND

This section provides background information related to the presentdisclosure which is not necessarily prior art.

A subject, such as a human patient, may select or be required to undergoa surgical procedure to correct or augment an anatomy of the patient.The augmentation of the anatomy can include various procedures, such asmovement or augmentation of bone, insertion of implantable devices, orother appropriate procedures. A surgeon can perform the procedure on thepatient based on images of the patient, which can be acquired using anx-ray scanner having an imaging system. The images may be acquired priorto, during and/or subsequent to the procedure. The imaging system maybe, for example, an O-Arm® medical imaging system such as those sold byMedtronic, Inc. or C-Arm imaging system. The images may be fluoroscopicor radiographic images depending on an operating mode of the imagingsystem.

The acquired images of the patient can assist a surgeon in planning andperforming the procedure, as well as evaluating results of theprocedure. A surgeon may select a two dimensional image or a threedimensional image representation of the patient. The images can assistthe surgeon in performing a procedure with a less invasive technique byallowing the surgeon to view the anatomy of the patient without removingoverlying tissue (including dermal and muscular tissue) when performinga procedure.

An O-Arm imaging system includes an ‘O’-shaped gantry and an ‘O’-shapedrotor. A C-Arm imaging system includes a ‘C’-shaped gantry and a‘C’-shaped rotor. Each of these imaging systems typically includes anx-ray source and an x-ray detector mounted opposite each other on thecorresponding rotor. Each of the x-ray sources generates x-rays, whichare directed at a subject. Each of the x-ray detectors detects thex-rays subsequent to the x-rays passing through the subject.

As an example, an imaging system may include an x-ray source, an x-raydetector, and a generator. The generator converts a low-voltage (e.g.,400 volts (V)) to a high-voltage (e.g., 150 kilo-volts (kV)). Thehigh-voltage is provided to the x-ray source to generate x-rays. For asame dosage period and amount of current, the higher the low-voltage andthus the higher the high-voltage, the higher the dosage of x-raysreceived by the patient. Similarly, for the same low-voltage, the higherthe current level and/or the longer the dosage period, the higher thedosage of x-rays received by the patient.

The voltage, current and dosage periods can be adjusted by a surgeon (orsystem operator). A surgeon may intuitively increase the voltage,current and/or dosage periods in an attempt to provide improved images.This not only increases x-ray dosage to a patient, but can also decreasequality of acquired images. Increasing voltage, current and/or dosageperiods can cause: x-ray detectors to be overloaded; images to be“grainy” and/or “spotted”; and/or image quality to decrease during aprocedure.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.According to various embodiments, provided is a system that includes aninitialization module, an imaging module, an alignment module, aprocessing module, and setting module. The initialization module isconfigured to obtain patient parameters for a patient, procedureparameters, and surgeon parameters. The initialization module isconfigured to select first settings for an x-ray source based on thepatient parameters, the procedure parameters, and the surgeonparameters. The image module is configured to obtain (i) a first sampleset of one or more images of a region-of-interest of the first patient,and (ii) a master sample set of one or more images. The first sample setof one or more images were acquired as a result of the x-ray sourceoperating according to the first settings. The alignment module isconfigured to align the first sample set of one or more images to themaster sample set of one or more images. The processing module isconfigured to process pixel data corresponding to a result of thealignment based on a pixel parameter or one of the patient parameters.The setting module is configured to adjust the first settings to provideupdated settings. X-ray dosage associated with the updated settings isless than x-ray dosage associated with the first settings.

In other features, a method is provided and includes obtaining patientparameters for a first patient, procedure parameters, and surgeonparameters, where the initialization module is configured to selectfirst settings for an x-ray source based on the patient parameters, theprocedure parameters, and the surgeon parameters. The method furtherincludes obtaining (i) a first sample set of one or more images of aregion-of-interest of the first patient, and (ii) a master sample set ofone or more images, where the first sample set of one or more imageswere acquired as a result of the x-ray source operating according to thefirst plurality of settings. The method yet further includes: aligningthe first sample set of one or more images to the master sample set ofone or more images; processing pixel data corresponding to a result ofthe alignment based on a pixel parameter or one of the patientparameters; and adjusting the first settings to provide updatedsettings, where x-ray dosage associated with the updated settings isless than x-ray dosage associated with the first plurality of settings.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1 is a functional block diagram of an imaging network includingprocedural operating systems with source control modules in accordancewith an embodiment of the present disclosure;

FIG. 2 is an environmental view of an imaging system including a sourcecontrol module in accordance with an embodiment of the presentdisclosure;

FIG. 3 is functional block diagram of a portion of an imaging system ofFIG. 1 or 2;

FIG. 4 is a functional block diagram of a navigation processing modulein accordance with an embodiment of the present disclosure; and

FIGS. 5A-5B illustrate a method of operating a procedural operatingsystem in accordance with an embodiment of the present disclosure.

DETAILED DESCRIPTION

Imaging systems and methods are disclosed herein that maintain orimprove image quality and minimize x-ray dosages of patients overtraditional imaging systems. The disclosed imaging systems can beconsidered intelligent imaging systems that monitor, track and learnimaging system and surgeon parameters associated with x-ray dosagesgenerated during various procedures. The imaging systems monitor trendsand provide feedback to the surgeons to improve settings for improvedimage quality and reduced x-ray dosage.

The following description is merely exemplary in nature. It should beunderstood that throughout the drawings, corresponding referencenumerals indicate like or corresponding parts and features. Although thefollowing teachings are primarily described with respect to an imagingsystem, such as an O-Arm® medical imaging system such as those sold byMedtronic, Inc. or C-Arm imaging system, the teachings may be applied toother imaging systems.

FIG. 1 shows an imaging network 10 that may include a server 12, acentral provider device 14, a network 16, and procedural operatingsystems 18. A procedural operating system may be located at a site andinclude a navigation system and an imaging system, as further describedbelow. Each of the procedural operating systems 18 includes a sourcecontrol module 19. The source control modules 19 control x-rays sources(an example of which is shown in FIG. 2) for x-ray imaging performed bythe procedural operating systems 18. Various parameters are monitored,tracked and stored in the procedural operating systems 18, which may betransmitted to the central provider device 14 via the network 16. Thesource control modules 19 may generate recommended settings for x-rayimaging and/or receive recommended settings from the central providerdevice 14. The central provider device 14 may generate recommendedsettings based on the parameters received from the procedural operatingsystems 18. The server 12, central provider device 14 and proceduraloperating systems 18 may include respective memories and transceiversfor storing and transmitting the parameters. The network 16 may be alocal area network, a wide area network, a wireless network, etc. Thenetwork 16 may include an Internet.

The server 12 may store records, such as procedure records 20, patientrecords 22, and surgeon records 24, as well as tables 26. The procedurerecords 20 may store procedure parameters corresponding to respectiveprocedures. The procedure parameters may include recommended parametersand/or provider parameters. The recommended parameters may be parametersrecommended based on monitored, tracked, and/or historical values,predetermined values, and/or provider parameters. The providerparameters may be parameters recommended by a provider (e.g., thecentral provider device 14). The recommended parameters and the providerparameters may each include imaging system settings used duringdifferent procedures and conducted by different surgeons. The imagingsystem settings may include x-ray source voltages (e.g., in kilo-volts),generator voltages, current levels (e.g., in milli-amperes), dosageperiods (e.g., in seconds), and/or other imaging system settings. Therecommended parameters and the provider parameters may be determined bythe source control modules 19 and/or the central provider device 14. Thecentral provider device 14 may generate the recommended parametersand/or the provider parameters based on the parameters collected and/orrecommended by the source control modules 19.

The patient records 22 may each include patient parameters. Each of thepatient records may include parameters for a particular patient andcorresponding procedure. More than one record may be stored for apatient that has or is to undergo multiple procedures. The patientparameters for each record may include: a patient identifier (ID);weight of the patient; one or more regions-of-interest (ROIs); size ofthe patient (e.g., dimensions of patient); volume of a portion of or awhole body of the patient; shape of an organ, a bone, a ROI, or otherportion of the patient; gender; age; medical history; ID of anatomy(e.g., ID of cranium, knee, spine, or other portion of the patient); IDof ROI; and/or other patient parameters. The size and/or weight of thepatient can be indicative of a percentage of fat tissue in the patient.A ROI may include one or more body parts. The dimensions of the patientmay include dimensions of body parts and/or a whole body of the patient.The dimensions may be simple to include, for example, height, width,length or may be complex dimensions to identify a periphery (or outerdimensions) of the body part or whole body. The dimensions may be ofinternal organs or bones. The dimensions may be of ROIs.

The surgeon records may include parameters for respective surgeons andcorresponding procedures. Each record may be associated with aparticular surgeon, a particular procedure, and/or one or more patientshaving similar patient parameters. Each record may include surgeonparameters, which may include: an ID of the surgeon; low and/or highx-ray source voltages for each patient; generator voltages; generatorcurrent levels; x-ray source current levels for each patient; typicalsurgeon low and/or high x-ray source voltages for the particularprocedure; typical surgeon x-ray source current levels for theparticular procedure; last used low and/or high x-ray source voltages;last used x-ray source current levels; dosage periods for a particularpatient; typical and/or last used dosage periods; x-ray source dutycycles; x-ray source ON periods; x-ray source OFF periods; etc.

The tables 26 may relate the parameters and/or settings stored in therecords 20, 22, 24 to recommended x-ray source settings. The tables 26are not static, but rather may be continuously modified and added toprior to, during and/or subsequent to procedures performed. Therecommended x-ray source settings may be based on determined imagequality values and x-ray dosages. The recommended x-ray source settingsmay be predetermined, determined by one or more of the source controlmodules 19, and/or determined by the central provider device 14, asdescribed above. The recommended x-ray source settings may be based onimage quality values determined by an image control module (an exampleof which is shown in FIG. 2) and/or the source control modules 19 and/orindicated by surgeons during and/or subsequent to correspondingperformed procedures. The indicated image quality values may be input bythe surgeons to the source control modules 19. A procedure may be doneon a cadaver or a live patient.

FIG. 2 shows an operating theatre (or inside of an operating room) 30and a user 31 (e.g., a physician) performing a procedure on a subject(e.g., a patient) 32. In performing the procedure, the user 31 uses animaging system 33 to acquire image data of the patient 32. The imagedata acquired of the patient 32 can include two-dimensional (2D) orthree-dimensional (3D) images. Models may be generated using theacquired image data. The model can be a three-dimension (3D) volumetricmodel generated based on the acquired image data using varioustechniques, including algebraic iterative techniques. The image data(designated 34) can be displayed on a display device 35, andadditionally, may be displayed on a display device 36 a associated withan imaging computing system 36. The displayed image data 34 may include2D images, 3D images, and/or a time changing 4D images. The displayedimage data 34 may also include acquired image data, generated imagedata, and/or a combination of the acquired and generated image data.

Image data acquired of the patient 32 may be acquired as 2D projections.The 2D projections may then be used to reconstruct 3D volumetric imagedata of the patient 32. Also, theoretical or forward 2D projections maybe generated from the 3D volumetric image data. Accordingly, image datamay be used to provide 2D projections and/or 3D volumetric models.

The display device 35 may be part of a computing system 37. Thecomputing system 37 may include a variety of computer-readable media.The computer-readable media may be any available media that is accessedby the computing system 37 and may include both volatile and nonvolatilemedia, and removable and non-removable media. By way of example, thecomputer-readable media may include computer storage media andcommunication media. Storage media includes, but is not limited to, RAM,ROM, EEPROM, flash memory or other memory technology, CD-ROM, DigitalVersatile Disk (DVD) or other optical disk storage, magnetic cassettes,magnetic tape, magnetic disk storage or other magnetic storage devices,or any other medium which can be used to store computer-readableinstructions, software, data structures, program modules, and other dataand which can be accessed by the computing system 37. Thecomputer-readable media may be accessed directly or through a networksuch as the Internet.

In one example, the computing system 37 can include an input device 38,such as a keyboard, and one or more processors 39 (the one or moreprocessors may include multiple-processing core processors,microprocessors, etc.) that may be incorporated with the computingsystem 37. The input device 38 may include any suitable device to enablea user to interface with the computing system 37, such as a touchpad,touch pen, touch screen, keyboard, mouse, joystick, trackball, wirelessmouse, audible control or a combination thereof. Furthermore, while thecomputing system 37 is described and illustrated herein as comprisingthe input device 38 discrete from the display device 35, the computingsystem 37 may include a touchpad or tablet computing device and may beintegrated within or be part of the computing system 37. A connection(or communication line) 40 may be provided between the computing system37 and the display device 35 for data communication to allow driving thedisplay device 35 to illustrate the image data 34.

The imaging system 33 may be an O-Arm imaging system, a C-Arm imagingsystem or other suitable imaging system. The imaging system 33 mayinclude a mobile cart 41, the imaging computing system 36 and a gantry42 (or x-ray scanner gantry). The gantry 42 includes an x-ray source 43,a collimator (not shown), a multi-row detector 44, a flat panel detector45 and a rotor 46. The x-ray source 43 may include a generator and/ormay be connected to a generator. With reference to FIG. 2, the mobilecart 41 may be moved from one operating theater or room to another andthe gantry 42 may be moved relative to the mobile cart 41. This allowsthe imaging system 33 to be mobile and used for various procedureswithout requiring a capital expenditure or space dedicated to a fixedimaging system. Although the gantry 42 is shown as being mobile, thegantry 42 may not be connected to the mobile cart 41 and may be in afixed position.

The gantry 42 may define an isocenter of the imaging system 33. In thisregard, a centerline C1 through the gantry 42 defines an isocenter orcenter of the imaging system 33. Generally, the patient 32 can bepositioned along the centerline C1 of the gantry 42, such that alongitudinal axis of the patient 32 is aligned with the isocenter of theimaging system 33.

The imaging computing system 36 may control the movement, positioningand adjustment of the multi-row detector 44, the flat panel detector 45and the rotor 46 independently to enable image data acquisition via animage processing module 47 of the processor 39. The processed images maybe displayed on the display device 35.

During operation, the x-ray source 43 emits x-rays through the patient32, which are detected by the multi-row detector 44 or the flat paneldetector 45. The x-rays emitted by the x-ray source 43 may be shaped bythe collimator and emitted for detection by the multi-row detector 44 orthe flat panel detector 45. The collimator may include one or moreleaves, which may be controlled to shape the x-rays emitted by the x-raysource 43. The collimator may shape the x-rays emitted by the x-raysource 43 into a beam that corresponds with the shape of the multi-rowdetector 44 and the flat panel detector 45. The multi-row detector 44may be selected to acquire image data of low contrast regions of theanatomy, such as regions of soft tissue. The flat panel detector 45 maybe selected to acquire image data of high contrast regions of theanatomy, such as bone. The x-ray source 43, the collimator, themulti-row detector 44 and the flat panel detector 45 may each be coupledto and/or mounted on the rotor 46.

The multi-row detector 44 and the flat panel detector 45 may be coupledto the rotor 46 to be (i) diametrically opposed from the x-ray source 43and the collimator within the gantry 42, and (ii) independently movablerelative to each other and into alignment with the x-ray source 43 andthe collimator. In one example, the multi-row detector 44 may bepositioned such that the flat panel detector 45 may be adjacent to themulti-row detector 44. In one alternative example, the flat paneldetector 45 may be moved over the multi-row detector 44 into alignmentwith the x-ray source 43 when an image using the flat panel detector 45is acquired. In another example, the multi-row detector 44 may bepositioned over the flat panel detector 45. As a further alternative,the multi-row detector 44 and the flat panel detector 45 may each beseparately movable, such that the selected multi-row detector 44 or flatpanel detector 45 may be aligned with the x-ray source 43 and thecollimator. The selected one of the multi-row detector 44 and the flatpanel detector 45 may be aligned with the x-ray source 43 and thecollimator when the selected one of the multi-row detector 44 and theflat panel detector 45 is substantially opposite or about 180 degreesapart from the x-ray source 43 and the collimator.

As the x-ray source 43, collimator, multi-row detector 44 and flat paneldetector 45 are coupled to the rotor 46, the x-ray source 43,collimator, multi-row detector 44 and flat panel detector 45 are movablewithin the gantry 42 about the patient 32. Thus, the multi-row detector44 and the flat panel detector 45 are able to be rotated in a 360°motion around the patient 32, as indicated by arrow 48. The x-ray source43 and collimator may move in concert with at least one of the multi-rowdetector 44 and the flat panel detector 45 such that the x-ray source 43and collimator remain generally 180° apart from and opposed to themulti-row detector 44 or flat panel detector 45.

The gantry 42 has multiple degrees of freedom of motion. The gantry 42may be isometrically swayed or swung (herein also referred to asiso-sway) relative to table 49 on which the patient 32 is disposed. Theisometric swing is indicated by arrow 50. The gantry 42 may be: tiltedrelative to the patient 32 (as indicated by arrow 51); movedlongitudinally relative to the patient 32 (as indicated by arrow 52);moved up and down relative to the mobile cart 41 and transversely to thepatient 32 (as indicated by arrow 53); and moved away from or towardsthe mobile cart 41 (as indicated by arrow 54). These different degreesof freedom of motion of the gantry 42 allow the x-ray source 43,collimator, multi-row detector 44 and flat panel detector 45 to bepositioned relative to the patient 32.

The imaging system 33 may be precisely controlled by the imagingcomputing system 36 to move the x-ray source 43, collimator, themulti-row detector 44 and the flat panel detector 45 relative to thepatient 32 to generate precise image data of the patient 32. Inaddition, the imaging system 33 may be connected with the processor 39via connection 55 which includes a wired or wireless connection orphysical media transfer from the imaging system 33 to the processor 39.Thus, image data collected with the imaging system 33 may also betransferred from the imaging computing system 36 to the computing system37 for navigation, display, reconstruction, etc.

The imaging system 33 may also be used during an unnavigated ornavigated procedure. In a navigated procedure, a localizer, includingeither or both of an optical localizer 60 and an electromagneticlocalizer 62, may be used to generate a field or receive or send asignal within a navigation domain relative to the patient 32. Ifdesired, the components associated with performing a navigated proceduremay be integrated within the imaging system 33. The navigated space ornavigational domain relative to the patient 32 may be registered to theimage data 34 to allow registration of a navigation space defined withinthe navigational domain and an image space defined by the image data 34.A patient tracker (or a dynamic reference frame) 64 may be connected tothe patient 32 to allow for a dynamic registration and maintenance ofthe registration of the patient 32 to the image data 34.

An instrument 66 may then be tracked relative to the patient 32 to allowfor a navigated procedure via a navigation system 81. The instrument 66may include an optical tracking device 68 and/or an electromagnetictracking device 70 to allow for tracking of the instrument 66 witheither or both of the optical localizer 60 or the electromagneticlocalizer 62. The instrument 66 may include a communication line 72 witha navigation interface device 74, which may communicate with theelectromagnetic localizer 62 and/or the optical localizer 60. Thenavigation interface device 74 may then communicate with the processor47 via a communication line 80. The connections or communication lines40, 55, 76, 78, or 80 can be wire based as shown or the correspondingdevices may communicate wirelessly with each other.

The instrument 66 may be an interventional instrument and/or an implant.Implants may include a ventricular or vascular stent, a spinal implant,neurological stent or the like. The instrument 66 may be aninterventional instrument such as a deep brain or neurologicalstimulator, an ablation device, or other appropriate instrument.Tracking the instrument 66 allows for viewing the location of theinstrument 66 relative to the patient 32 with use of the registeredimage data 34 and without direct viewing of the instrument 66 within thepatient 32. For example, the instrument 66 may be graphicallyillustrated as an icon superimposed on the image data 34.

Further, the imaging system 33 may include a tracking device, such as anoptical tracking device 82 or an electromagnetic tracking device 84 tobe tracked with a respective optical localizer 60 or the electromagneticlocalizer 62. The tracking devices 82, 84 may be associated directlywith the x-ray source 43, multi-row detector 44, flat panel detector 45,rotor 46, the gantry 42, or other appropriate part of the imaging system33 to determine the location or position of the x-ray source 43,multi-row detector 44, flat panel detector 45, rotor 46 and/or gantry 42relative to a selected reference frame. As illustrated, the trackingdevices 82, 84 may be positioned on the exterior of the housing of thegantry 42. Accordingly, portions of the imaging system 33 including theinstrument 66 may be tracked relative to the patient 32 to allow forinitial registration, automatic registration or continued registrationof the patient 32 relative to the image data 34.

The image processing module (IPM) 47 may receive user input data fromthe input device 36 c and may output the image data 34 to the displaydevice 35 or the display device 36 a. The user input data may include arequest to acquire image data of the patient 32. Based on the user inputdata, the IPM 47 may generate a detector signal and a motion signal. Thedetector signal may include a selected detector for image acquisition.The motion signal may include a motion profile for the rotor 46 to moveto a selected location to acquire image data. The motion signal may be acommand or instruction signal that is provided from the IPM 47 to agantry control module 85. The gantry control module 85 may be includedin the gantry 42 and on the rotor 46 and position the rotor 46 based onthe instruction signal.

The processor 39 or the mobile cart 41 may include a navigation controlmodule (NCM) 87 and source control module (SCM) 89 (e.g., one of theSCMs 19 of FIG. 1). The NCM 87 tracks the instrument 66 relative to thepatient 32 to allow for illustration of the tracked location of theinstrument 66 relative to the image data 34 for performing a procedure.The SCM 89 may control, monitor, track, adjust and/or set x-ray sourceparameters (e.g., x-ray source voltages, current levels and/or dosageperiods). The SCM 89 may access procedure, patient, surgeon and/orrecommended parameters based on previous used, current and/or inputtedx-ray source parameters. The SCM 89 may provide recommended x-ray sourceparameters based on the accessed procedure, patient, surgeon and/orrecommended parameters and/or the previously used, current and/orinputted x-ray source parameters. This is described in further detailbelow. The IPM 47, NCM 87 and SCM 89 may communicate with each other andshare data. The IMP 47, NCM 87 and SCM 89 may be implemented as separatemodules as shown or may be implemented as a single module.

The IMP 47, NCM 87 and SCM 89 may be implemented in the imagingcomputing system 36, on the mobile cart 30, or as part of the processor26. The IPM 47 and/or SCM 89 may send a source signal to the x-raysource 43. The source signal may command the x-ray source 43 to outputor emit at least one or more x-ray pulses. The x-ray pulses aregenerated based on x-ray source parameters set by the SCM 89. The IPM 47and/or SCM 89 may send a collimator signal to the collimator. Thecollimator signal may indicate a selected shape of one or morecollimated x-ray pulses. The selected shape of the collimated x-raypulses may correspond to the selected one of the multi-row detector 44and the flat panel detector 45. In this regard, if the multi-rowdetector 44 is selected, the collimated x-ray pulses may be shaped bythe collimator to match the shape of the multi-row detector 44. If theflat panel detector 45 is selected, then the collimated x-ray pulses maybe shaped by the collimator to match the shape of the flat paneldetector 45.

The IPM 47 may also receive as input a multi-row detector signal, whichmay include the one or more collimated x-ray pulses detected by themulti-row detector 44. The image processing module 47 may receive asinput a flat panel detector signal, which may include the one or morecollimated x-ray pulses detected by the flat panel detector 45. Based onthe received collimated x-ray pulses, the image processing module 47 maygenerate the image data 34.

In one example, the image data 34 may include a single 2D image. Inanother example, the image processing module 47 may perform automaticreconstruction of an initial 3D model of an area of interest of thepatient 32. Reconstruction of the 3D model may be performed in anyappropriate manner, such as using algebraic techniques for optimization.The algebraic techniques may include Expectation maximization (EM),Ordered Subsets EM (OS-EM), Simultaneous Algebraic ReconstructionTechnique (SART) and total variation minimization. A 3D volumetricreconstruction may be provided based on the 2D projections.

The algebraic techniques may include an iterative process to perform areconstruction of the patient 32 for display as the image data 34. Forexample, a pure or theoretical image data projection, based on orgenerated from an atlas or stylized model of a “theoretical” patient,may be iteratively changed until the theoretical projection images matchthe acquired 2D projection image data of the patient 32. Then, thestylized model may be appropriately altered as the 3D volumetricreconstruction model of the acquired 2D projection image data of thepatient 32 and may be used in a surgical intervention, such asnavigation, diagnosis, or planning interventions. In this regard, thestylized model may provide additional detail regarding the anatomy ofthe patient 32, which may enable the user 31 to plan the surgicalintervention efficiently. The theoretical model may be associated withtheoretical image data to construct the theoretical model. In this way,the model or the image data 34 may be built based upon image dataacquired of the patient 32 with the imaging system 33. The IPM 47 mayoutput the image data 34 to the display device 36 a.

The processor 39 may receive as an input the detector signal and themotion signal from the IPM 47. The processor 39, based on the detectorsignal and/or the motion signal may transmit (via wires or wirelessly)control signals to the GCM 85. The GCM 85 may be located on the rotor46. Based on the detector signal, the GCM 85 may generate a first movesignal to move the selected one of the multi-row detector 44 or the flatpanel detector 45 into alignment with the x-ray source 43 and thecollimator. Based on the motion signal, the GCM 85 may also generate asecond move signal for the rotor 46 to move or rotate the rotor 46within the gantry 42 relative to the patient 32. The movement of thex-ray source 43, the collimator, the multi-row detector 44 and the flatpanel detector 45 about the patient 32 may be controlled to acquireimage data at selected locations and orientations relative to thepatient 32.

The 2D image data may be acquired at each of multiple annular positionsof the rotor 46. The 3D image data may be generated based on the 2Dimage data. Also, the gantry 42, the x-ray source 43, the multi-rowdetector 44 and the flat panel detector 45 may not be moved in a circle,but rather may be moved in another pattern, such as a spiral helix, orother rotary movement about or relative to the patient 32. This canreduce exposure of a patient to radiation. The pattern (or path) may benon-symmetrical and/or non-linear based on movements of the imagingsystem 33, such as the gantry 42. In other words, the path may not becontinuous in that the gantry 42 may be stopped and moved back in adirection along the path the gantry 42 previously followed. This mayinclude following previous oscillations of the gantry 42.

Inputs to the imaging system 33 may be received at the input device 36c, input device 38, or other control modules (not shown) within thecomputing system 37 or imaging computing system 36, and/or determined byother sub-modules (not shown) within the IPM 47. The IPM 47 may receiveuser input data requesting that image data of the patient 32 beacquired. The input data may include information as to whether theregion-of-interest on the patient 32 is a high contrast region (e.g.boney tissue) or a low contrast region (e.g. soft tissue). In oneexample, the user input data may include a region-of-interest on theanatomy of the patient 32. The IPM 47 may automatically determine to usethe multi-row detector 44 or the flat panel detector 45 based on theregion-of-interest. For example, the user may select (i) the multi-rowdetector 44 to acquire an image of soft tissue, and (ii) the flat paneldetector 45 to acquire an image of boney tissue.

Based on the user input data, the IPM 47 and/or the SCM 89 may generatesource data and detector type data. The IPM 47 may also generate motionprofile data and collimator data. The source data may includeinformation to output x-ray pulses or a signal to power-down the imagingsystem 33. The detector type data may include the selected multi-rowdetector 44 or flat panel detector 45 to acquire the image data. Themotion profile data may include a selected profile for the movement ofthe rotor 46 within the gantry 42. The collimator data may includeinformation to shape the x-ray pulses into collimated x-ray pulses tomatch the selected one of the multi-row detector 44 and flat paneldetector 45.

The IPM 47 may also receive as an input multi-row detector data and flatpanel detector data. The multi-row detector data may indicate the energyfrom the collimated x-ray pulses received by the multi-row detector 44.The flat panel detector data may indicate the energy from the collimatedx-ray pulses received by the flat panel detector 45. Based on themulti-row detector data and the flat panel detector data, the IPM 47 maygenerate the image data 34 and may output this image data 34 to thedisplay device 36 a or display device 35.

The processor 39 may receive as input the detector type data and themotion profile data. Based on the detector type data, the processor 39may generate flat panel move data or multi-row move data (and/orcorresponding signals). The flat panel move data may include a selectedposition for the flat panel detector 45 to move to in order to bealigned with the x-ray source 43 and collimator. The multi-row move datamay include a selected position for the multi-row detector 44 to move inorder to be aligned with the x-ray source 43 and collimator.

The processor 39 or a module thereof, based on the source data, maycause the x-ray source 43 to generate pulse data for control of thecollimator. The pulse data may include pulse data for at least one x-raypulse. The processor 39 and/or a module thereof may receive as an inputthe multi-row move data and the collimated pulse data. Based on themulti-row move data, the multi-row detector 44 may move into alignmentwith the x-ray source 43. Based on the received pulse data, theprocessor 39 and/or a module thereof may generate the multi-row detectordata (and/or a corresponding signal) for the IPM 47. The processor 39and/or a module thereof may receive as an input the flat panel move dataand the collimated pulse data. Based on the flat panel move data, theflat panel detector 45 may move into alignment with the x-ray source 43.Based on the received pulse data, the flat panel control module maygenerate the flat panel detector data (and/or a corresponding signal)for the IPM 47.

Based on the motion profile data, the processor 39 may generate rotormove data (and/or a corresponding signal) for the GCM 85. The rotor movedata may indicate a selected movement profile for the rotor 46 to movewithin the gantry 42 to enable the acquisition of the image data. TheGCM 85 may receive as an input the rotor move data. Based on the rotormove data, the rotor 46 may be moved within the gantry 42 to a desiredlocation in order to acquire the image data.

FIG. 3. shows a portion 100 of the imaging system 33 of FIG. 2. Theportion 100 may include the x-ray source 43, the GCM 85, the SCM 89, thex-ray detectors 44, 45 and a power source 102. The GCM 85 may include agantry transceiver 104, a gantry processing module 106 and a gantrypower control module 108. The gantry transceiver 104 may include agantry medium access control (MAC) module 110 and a gantry physicallayer (PHY) module 112. The gantry transceiver 104, the gantryprocessing module 106 and the power control module 108 may receive powerfrom the power source 102.

The SCM 89 includes a source transceiver 114, a source processing module116, and a source power control module 118. The source transceiver 114includes a source PHY module 120 and a source MAC module 122. The sourcetransceiver 114 and the source processing module 116 may receive powerfrom the source power control module 118, which receives power from asecond power source 124.

The gantry processing module 106 may wirelessly communicate with thesource processing module 116 via the transceivers 104, 114 andrespective antennas 130, 132. The gantry processing module 106 mayreceive sensor signals and/or information from sensors 140 directly orfrom the source control module 89. The gantry processing module 106,based on signals from the source processing module 116, may control (i)power supplied to and/or position and speed of the rotor 46, and (ii)power supplied to the x-ray source 43. The source processing module 116may generate a mode signal, which is provided to the gantry powercontrol module 108. The gantry power control module 108 may supply powerto actuators, motors, the x-ray source 43, and/or the detectors 44, 45based on the operating mode indicated by the mode signal. The powersupplied to the x-ray source 43 and the detectors 44, 45 are shown asPOW1 and POW2.

The source MAC module 122 generates control signals based on data and/orinformation received from the source processing module 116. The sourcePHY module 120 wirelessly transmits the control signals to the gantryPHY module 112. The source MAC module 122 may generate informationsignals based on data and/or information received from the sourceprocessing module 116. The information signals are transmittedwirelessly via the source PHY module 120 to the gantry PHY module 112.The gantry processing module 106 may control operation of the devices(e.g., x-ray source 43, x-ray detectors 44, 45, power control module108, etc.) based on the information signals and/or signals from thesensors 140.

The gantry power control module 108 may receive power from a generator(e.g., power source 102) or other power source. The power sources 102,124 may be the same or different power sources. The power may be basedon sensor signals from the sensors 140, which may be connected to thegantry control module 85 and/or the source control module 89.

The source control module 89 and/or the source processing module 116 maybe connected to and/or access a memory 150. The memory 150 may storevarious parameters (or settings) 152 and tables 154. The parameters 152may include any of the parameters herein described including procedureparameters, patient parameters, surgeon parameters, recommendedparameters, etc. The tables 154 may relate procedure, patient andsurgeon parameters to recommended parameters. The tables 154 are notstatic, but rather may be continuously modified and added to prior to,during and/or subsequent to procedures performed.

FIG. 4 shows an example of the source processing module (SPM) 116, whichmay include a mode module 200, an initialization module 202, an imagemodule 204, an alignment module 206, an image quality module 208, asetting module 210, a surgeon evaluation module 212, a continuity module214, a post processing module 216, a feedback module 218, a confirmationmodule 220, and a threshold checking and waring module 222. Thesemodules are described below with respect to FIGS. 5A-5B.

For further defined structure of the modules of FIGS. 1-4 see belowprovided method of FIGS. 5A-5B4 and below provided definition for theterm “module”. The systems FIGS. 1-2 and/or portions thereof may beoperated using numerous methods, an example method is illustrated inFIGS. 5A-5B. In FIGS. 5A-5B, a method of operating a proceduraloperating system or a portion thereof is shown. Although the followingtasks are primarily described with respect to the implementations ofFIGS. 1-4, the tasks may be easily modified to apply to otherimplementations of the present disclosure. The tasks may be iterativelyperformed.

The method may begin at 250. At 252, surgeon information is acquired viaan input device (e.g., the input device 38 and/or scanner). The surgeoninformation may include, for example, a surgeon ID or otheridentification information. The surgeon information may be uploadedautomatically when an ID badge of the surgeon is swiped and/or scannedvia the input device. The surgeon information may include a selectedprocedure and/or surgeon parameters including x-ray source parametersfor procedures conducted by the surgeon. The selected procedure may beindicated by the surgeon via the input device.

At 254, the SPM 116 may receive an input from the surgeon whichactivates an x-ray source parameter control method. The SPM 116 mayactivate the method based on the input. Task 258 may be performed if themethod is activated. The x-ray source parameter control method mayinclude the following tasks 258-318. This method may be activated whenthe surgeon, for example, enters the surgeon information and/or swipesor scans an ID badge at the input device. The SPM 116 may verify thesurgeon information prior to permitting the method to be activated. Ifthe method is not activated and/or the surgeon information is notapproved, the method may end at 256.

At 258, the SPM 116 performs a setup and/or initialization process tosetup and/or initialize the imaging system 33. This may includeselecting an operating mode (258A), obtaining procedure parameters(258B) if not already obtained, obtaining surgeon parameters (258C) ifnot already obtained, obtaining patient parameters (258D) for a selectedprocedure if not already obtained, obtaining recommended parameters(258E) for the procedure being performed, and orienting imagingacquiring portion of the imaging system (258F). Initial x-rays sourcesettings may be set as described below based on one or more of theparameters obtained during task 258. For example, x-ray source voltages,current levels and dosage periods may be selected based on patientparameters such as body size, region-of-interest, shapes of bones and/ororgans, etc. As another example, the x-ray source parameters may be setbased on other parameters, such as pixel intensities of previouslystored images for the selected procedure, etc. The x-ray source settingsmay be set to last or preset settings for the surgeon, site, imagingsystem, patient, and/or procedure being performed.

At 258A, mode module 200 selects an operating mode. The mode module 200selects an operating mode of the SPM 116 and/or other modules of theimaging system 33. The modes may include an auto-learn mode, a manualmode, a post processing mode, a patient specific mode and/or anon-patient specific mode. The mode module 200 may select one or more ofthe modes to operate in during the same period of time. For example, themode module 200 may select operation in one of the auto-learn mode,manual mode and post processing mode and may also select operation inone of the patient specific and non-patient specific modes.

During the auto-learn mode parameters are monitored, tracked and used toadjust x-ray source settings to recommended levels. During theauto-learn mode, settings may be automatically adjusted to recommendedlevels and a confirmation of the recommended levels may be requestedfrom a surgeon (or user). During the manual mode, parameters aremonitored, tracked and used to recommend x-ray source settings. Duringthe manual mode, the recommended levels are indicated, but the x-raysource levels are not automatically adjusted. The x-ray source settingsare not adjusted without surgeon acceptance and/or setting ofrecommended levels. The auto-learn mode and the manual mode may beperformed prior to and/or during a procedure.

The post processing mode may be performed subsequent to a procedureand/or while a procedure is not being performed. The post processingmode allows a surgeon to view and evaluate images taken during aprocedure and to post process the images based on different x-ray sourcesettings than that used during the procedure. This allows a surgeon todetermine improved x-ray source settings for subsequent procedures.System recommended settings may be provided to the surgeon during thepost processing mode as described below.

At 258B, 258C, 258D, 258E, parameters may be loaded from a memory (e.g.,the memory 150), a central provider device 14 and/or other storagedevice and/or centrally accessible device to the SPM 116. The parametersmay all be associated with the selected procedure and/or a similarprocedure. The parameters may include default parameters if, forexample, parameters are not available or are partially available for theselected procedure. The default parameters may be surgeon specific orindependent of the surgeon performing the selected procedure. X-raysource parameters may be selected by the setting module 210 and/or bythe surgeon. The surgeon may approve the selected settings. For example,the setting module 210 may (i) select recommended, preset, default,and/or surgeon preferred settings, and then (ii) generate a request forthe surgeon to confirm the settings. The surgeon may then confirm thesettings and/or modify the settings prior to proceeding to task 260. At258F, the imaging acquiring portion (e.g., the detectors 44, 45) may beoriented to target and/or predetermined initial positions prior to beingthe selected procedure.

At 260, the post processing module 216 and/or SPM 116 may determinewhether the post processing mode has been selected. If the SPM 116 isnot operating in the post processing mode, task 262 is performed,otherwise task 272 is performed.

At 262, the image module 204 may determine whether to acquire an imageor set of images. The image or set of images may be (i) an initial (orbaseline) image or set of images, (ii) an additional image or set ofimages, (iii) an image or set of images to be used as a master image ormaster set of images. A single image of a region-of-interest may beacquired or a set of images (e.g., slices of images of a region or bodypart (e.g., one or more bones and/or organs) of interest may beacquired. Each image or set of images acquired during an iteration oftask 264 may be referred to as a sample set. The determination ofwhether an image or image set is to be acquired may be based on whethera master image/image set is available and/or a predetermined minimumsample set is satisfied. The predetermined minimum sample set mayrequire one or more images of a region-of-interest and/or one or moreimages of each slice of a region and/or one or more body parts. If animage or set of images are to be acquired, task 264 is performed,otherwise task 272 is performed.

At 264, the image module 204 may acquire an initial image or set ofimages or another image or set of images, as described for task 262. Theimage module 204 may control the x-ray source 43 and the detectors 44,45 to acquire the image(s). The x-ray source 43 may be operated usingx-ray source parameters loaded and/or selected in prior tasks.

At 266, the image module 204 and/or the quality module 208 may determinequality of the image(s) acquired at 264 are greater than a predeterminedthreshold. This may include determining pixel intensities and/or otherpixel parameters (contrast ratios, brightness levels, etc.) andcomparing to predetermined values to determine the quality of theimage(s). The image quality values may be based on surgeon inputsindicating a surgeon ranking of the quality levels of the images. Ifthere is more than one image, an average quality value may be determinedfor the images and compared to the predetermined threshold. If thequality of the acquired images is less than the predetermined threshold,task 267 may be performed, otherwise task 268 may be performed. If task267 is performed, the acquired images may be discarded and/or stored forfuture reference.

At 267, the x-ray source settings may be adjusted. The surgeon maymanually adjust the settings or the settings may be automaticallyadjusted and the surgeon may be prompted to confirm the settings basedon the operating mode. If operating in the manual mode, the adjustedsettings may be recommended based on historical data and the surgeon maythen accept the setting, maintain the current settings, or inputdifferent settings. If operating in the auto-learning mode, recommendedadjustments (updated settings) may be provided and set and the surgeonmay be prompted to confirm the updated settings. If the surgeon does notaccept the updated settings, the previous settings are maintained unlessthe surgeon enters different settings and/or adjustment values. Similartasks are performed at 302-318. Task 262 is performed subsequent to task267.

At 268, the image module 204 may determine whether to set the acquiredimage or image set as the master image or master image set. This mayoccur, for example, if a previous master image or master image set isnot already stored and/or acquired. This may also or alternatively occurif the surgeon indicates via the input device for the most recentlyacquired image or image set be the master (or preset) image or master(or preset) image set. Task 270 is performed if the last acquired imageor image set is to be the master image or master image set, otherwisetask 280 is performed. At 270, the last acquired image or image set istagged to be identified as the master. Subsequently acquired images maybe compared to the master. Task 280 may be performed subsequent to task270.

At 272, the image module 204 may determine whether to access apreviously stored master image or master image set. Task 272 may beperformed while operating in the auto-learn mode, the manual mode or thepost processing mode. This may be based on an input received from thesurgeon and/or a setting stored and associated with the surgeonindicating access of the master image or master image set. The masterimage/image set may be stored in the above-mentioned memory. The masterimage/image set may be a last acquired image/image set. Task 274 isperformed if a master image/image set is accessed, otherwise task 276 isperformed. At 274, the image module 204 accesses the previously storedmaster image/image set. Task 280 may be performed subsequent to task274.

At 276, the image module 204 may determine whether to access apreviously stored image or image set (i.e. non-master image/image set).This may be based on an input received from the surgeon and/or a settingstored and associated with the surgeon indicating access of the image orimage set. The image/image set may be stored in the above-mentionedmemory. The image/image set may be a last acquired image/image set orother image/image set. Task 278 is performed if an image/image set isaccessed, otherwise task 280 is performed. At 278, the image module 204accesses the previously stored image/image set.

At 280, the image module 204 may determine whether the predeterminedminimum sample set threshold has been met. If this threshold has beenmet, task 282 is performed, otherwise task 260 may be performed.

At 282, the alignment module 206 may adjust zoom levels and/or rotateone or more of the acquired and/or accessed image(s) to correspondingones of the master image(s). At 284, the alignment module 206 performsedge alignment to align the master, acquired, and/or accessed imagesand/or portions thereof relative to each other. This may includecomparing pixel parameters (e.g., brightness, intensity levels, color,contrast ratios, sharpness values, etc.) for the images to find edges ofbones, tissue, organs, body parts, regions of interest, etc. Differencesin adjacent pixels may be determined to located edges. A predeterminednumber of pixels of each of the images in respective quadrants of theimages may be compared. As an example, a predetermined number ofbrightest pixels and/or pixels providing a predetermined pattern may becompared to align the images and/or portions thereof. Horizontal rowsand/or vertical rows of pixels may be compared. Full or partial portionsof the images may be scanned to provide a “best-fit” alignment. Asanother example, each of the pixels has a unique set of values (e.g.,red, green and blue values), which may be compared to provide a best-fitalignment. Differences between the red, green and blue values adjacentpixels of each image may be compared to differences between red, greenand blue values of adjacent pixels of the other images to provide thebest-fit alignment. Edge alignment can be performed to minimize and/oreliminate offsets between the images and/or portions thereof. The imagesmay be scaled prior to and/or during alignment based on x-ray sourcesettings used for each of the images.

At 286, the alignment module 286 may determine whether a valid alignmentof the images or portions thereof has been established. If differencesbetween corresponding pixels of different images are on average within apredetermined range or if transitions (differences between adjacentpixels) of each image are within predetermined ranges of each other,then a valid alignment may have been performed. Task 288 may beperformed if an invalid alignment has been performed, otherwise task 294may be performed.

At 288, the alignment module 288 may determine if an alignment has beenattempted (task 284 has been performed) more than a predetermined numberof times for the current images. If an alignment has been attempted morethan the predetermined number of times, then task 290 is performed,otherwise the alignment module 288 returns to task 286. At 290, analignment error may be reported to the surgeon via, for example, thedisplay device 35. If task 290 is performed, the SPM 116 may return totask 260 to acquire and/or access additional images. Subsequent to task290, the method may end at 292.

At 294, the quality module 208 may process a result of the alignmentincluding the aligned images. This may include processing pixelregions-of-interest and evaluating separate and/or combined imagequality values of (i) the images separately prior to alignment, and/or(ii) a combined result of the aligned images subsequent to alignment. Inone embodiment, pixel regions-of-interest of the latest sample set ofimages after alignment are alone processed to provide image qualityvalues.

During task 294, a second set of image quality values (or one or moresets of image quality values) may be determined. The processing ofresults of the alignment may be based on pixel parameters (e.g., pixelintensity values, continuity values, or other herein disclosed pixelparameters) and/or patient parameters, which may be compared withpredetermined values and/or weighted and then compared to predeterminedvalues. The weighted values may be based on pixel parameters; averagepixel intensity levels of the images; patient parameters; age of theimages; whether the images are of the current patient; whether theimages are for the current procedure or a similar procedure; qualitylevels as indicated by the surgeon; and/or other stored quality values;etc. The determined second set of quality values may be determined basedon a number and/or percentage of pixels within a region-of-interest thathave pixel parameters within predetermined respective ranges.

At 296, the SPM 116 and/or post processing module 216 may proceed totask 300 if not operating in the post processing mode, otherwise mayproceed to task 312. At 300, the setting module 210 may determinewhether an amount of time since a last adjustment of the x-ray sourcesettings is greater than or equal to a predetermined period. If theamount of time since the last adjustment is greater than or equal to thepredetermined period, then task 302 may be performed.

At 302, the SPM 116 continues to task 304 if operating in the auto-learnmode, otherwise the SPM 116 performs task 312. At 304, the settingmodule 210, continuity module 214, and/or SPM 116 adjusts the currentx-ray source settings to updated values. This may include determiningadjustments to current values and/or updated values. This may includeproviding calculated, looked-up and/or recommended adjustments and/orupdated values. The adjustments and/or updated values may be determinedbased on the tables 154, which may relate procedure parameters, patientparameters, surgeon parameters, x-rays source parameters, and imagequality values for the patient 32, the imaging system 33, and/or otherpatients and imaging systems to provide recommended x-rays sourcesettings for maximum image quality and minimum x-ray dosage. During thepatient specific mode only values pertaining to the patient 32 may beused. During the non-patient specific mode, values of other patients maybe used. Maximum image quality and minimum x-ray dosage values may havebeen previously verified. The updated settings may provide reduced x-raydosage values as compared to the previously used settings. This may bebased on the second set of quality values determined at 294 and/or anyof the parameters obtained during task 258. The tables may bemulti-dimensional tables having any number of different parameters.

If there is lack of continuity between current images (or currentlyacquired images) and previously stored images, then default x-ray sourcesettings or best-fit settings may be selected. For example, this mayoccur if there are a lack of records with images for the patient(non-standard patient or non-typical patient) and/or condition of thepatient for which the procedure is being performed. For example, theremay be a lack of images for rare conditions, such as scoliosis or otherrare conditions.

At 306 and while operating in the auto-learn mode, the confirmationmodule 220 may request the surgeon to confirm the updated settings. Ifthe updated settings are confirmed, task 308 is performed, otherwisetask 310 is performed. At 308, the adjusted settings are maintained forsubsequent imaging and/or processing and may be stored in the memoryand/or provided to the central provider device 14 for future use by theimaging system 33 and/or other imaging systems. At 310, the confirmationmodule 220 returns to the x-ray source settings used prior to the updateand does not maintain the updated settings. Subsequent to tasks 308,310, task 260 may be performed.

At 312, the setting module 210 and/or the post processing module 216while operating in the post processing mode or manual mode provides thesettings determined at 304. The settings may be indicated via thedisplay to the surgeon. The surgeon may then continue the currentsettings and/or accept the recommended settings. If the recommendedsettings are accepted, as determined at 316, the setting module updatesthe settings. If the settings are not accepted task 360 may beperformed. Task 312 may also include displaying modified images based onthe updated settings to provide examples of how the images would look ifthe updated settings were used. This may include post processing theimages using filters and/or other image enhancement techniques. This mayinclude adjusting pixel intensities of the images. The surgeon may beprompted of the difference in x-ray dosage for the updated x-ray sourcesettings relative to the x-ray dosage exhibited for x-ray sourcesettings used to provide the previously acquired and/or accessed images.

At 314, the updated settings may be stored as another set of settingsfor the surgeon and/or procedure, as performed at 308. At 316, if theupdated settings are accepted and/or to be stored as preset (or master)settings, task 318 is performed, otherwise task 260 is performed. Thesurgeon may be prompted as to whether the updated settings are to bestored as preset or master settings for future iterations of thismethod.

The above-described tasks are meant to be illustrative examples; thetasks may be performed sequentially, synchronously, simultaneously,continuously, during overlapping time periods or in a different orderdepending upon the application. Also, any of the tasks may not beperformed or skipped depending on the implementation and/or sequence ofevents.

The SPM 116 and/or the surgeon evaluation module 212 of the imagingsystem 33 may monitor trends of surgeons. This may include monitoringx-rays source parameter trends of a particular surgeon relative to x-raysource trends of other surgeons for similar patient parameters andprocedure parameters. These trends may also be compared to recommendedx-ray source settings. The feedback module 218 may provide feedback to asurgeon and/or other user via the display device 35 indicating whetherthe surgeon is following trends of other surgeons or is using x-raysource settings that result in poorer image quality and/or higher x-raydosages. The feedback may be provided to and/or similarly determined bythe central provider device 14. The feedback may also indicate whetherthe trends of a surgeon are away from recommended settings and/ortypical differences between the surgeon settings and the recommendedsettings. The surgeon evaluation module 212 may also predict a trend ofa surgeon for a particular patient and/or procedure. For example, if thesurgeon is gradually increase or decreasing x-ray source settings overtime or is consistently using certain x-ray source settings, thisinformation may be indicated via the display device.

The post processing mode allows a surgeon to evaluate images acquiredduring a surgery using the above-described method and then use updatedsettings determined by the method in subsequent procedures for improvedimage quality and/or reduced x-ray dosage.

The threshold checking/warning module 222 may determine if the x-raysource settings selected by a surgeon are outside predetermined rangesof (i) settings typically used by other surgeons for a similar patientand a similar procedure, and/or (ii) recommended (central prover and/orindustry recommended) settings. If outside the stated predeterminedranges and/or any of the x-ray source settings are greater than or equalto predetermined maximum values, then the threshold checking/warningmodule 222 may prompt the surgeon to change the selected settings.Typical surgeon settings and/or recommended settings may be indicated tothe surgeon and the surgeon may be prompted whether the typical surgeonsettings and/or recommended settings are acceptable. Sample images maybe provided for the typical surgeon settings and/or recommendedsettings, as described above. The threshold checking/warning module 222may prompt a user and/or prevent imaging if one or more of the x-raysource settings are outside a predetermined range, which would result inx-ray dosage greater than a predetermined level.

The above-disclosed methods allow post analysis of images to provideradiation trends using image detection algorithms andregions-of-interest. Target and/or recommended x-ray source settings maythen be provided based on estimated and/or determined patient parameters(e.g., body habitus) to then provide recommended settings back to theuser. This includes types of images that an imaging system at aparticular site typically provides for the recommended settings.Information pertaining to how an imaging system is being used at aparticular site may be provided back to a central provider device and/orindicated to the user and/or a technician.

In the above-described method, image sample sets may be acquired atpredetermined frequencies such that post processing of the images may beperformed. Parameters associated with each of the image sets may belogged for future evaluation. Each image set may be for a particularpatient, surgeon, one or more procedures, one or moreregions-of-interest, etc.

The wireless communications described in the present disclosure can beconducted in full or partial compliance with IEEE standard 802.11-2012,IEEE standard 802.16-2009, IEEE standard 802.20-2008, and/or BluetoothCore Specification v4.0. In various implementations, Bluetooth CoreSpecification v4.0 may be modified by one or more of Bluetooth CoreSpecification Addendums 2, 3, or 4. In various implementations, IEEE802.11-2012 may be supplemented by draft IEEE standard 802.11ac, draftIEEE standard 802.11ad, and/or draft IEEE standard 802.11ah.

The foregoing description is merely illustrative in nature and is in noway intended to limit the disclosure, its application, or uses. Thebroad teachings of the disclosure can be implemented in a variety offorms. Therefore, while this disclosure includes particular examples,the true scope of the disclosure should not be so limited since othermodifications will become apparent upon a study of the drawings, thespecification, and the following claims. It should be understood thatone or more steps within a method may be executed in different order (orconcurrently) without altering the principles of the present disclosure.Further, although each of the embodiments is described above as havingcertain features, any one or more of those features described withrespect to any embodiment of the disclosure can be implemented in and/orcombined with features of any of the other embodiments, even if thatcombination is not explicitly described. In other words, the describedembodiments are not mutually exclusive, and permutations of one or moreembodiments with one another remain within the scope of this disclosure.

Spatial and functional relationships between elements (for example,between modules, circuit elements, semiconductor layers, etc.) aredescribed using various terms, including “connected,” “engaged,”“coupled,” “adjacent,” “next to,” “on top of,” “above,” “below,” and“disposed.” Unless explicitly described as being “direct,” when arelationship between first and second elements is described in the abovedisclosure, that relationship can be a direct relationship where noother intervening elements are present between the first and secondelements, but can also be an indirect relationship where one or moreintervening elements are present (either spatially or functionally)between the first and second elements. As used herein, the phrase atleast one of A, B, and C should be construed to mean a logical (A OR BOR C), using a non-exclusive logical OR, and should not be construed tomean “at least one of A, at least one of B, and at least one of C.”

In this application, including the definitions below, the term “module”or the term “controller” may be replaced with the term “circuit.” Theterm “module” may refer to, be part of, or include: an ApplicationSpecific Integrated Circuit (ASIC); a digital, analog, or mixedanalog/digital discrete circuit; a digital, analog, or mixedanalog/digital integrated circuit; a combinational logic circuit; afield programmable gate array (FPGA); a processor circuit (shared,dedicated, or group) that executes code; a memory circuit (shared,dedicated, or group) that stores code executed by the processor circuit;other suitable hardware components that provide the describedfunctionality; or a combination of some or all of the above, such as ina system-on-chip.

The module may include one or more interface circuits. In some examples,the interface circuits may include wired or wireless interfaces that areconnected to a local area network (LAN), the Internet, a wide areanetwork (WAN), or combinations thereof. The functionality of any givenmodule of the present disclosure may be distributed among multiplemodules that are connected via interface circuits. For example, multiplemodules may allow load balancing. In a further example, a server (alsoknown as remote, or cloud) module may accomplish some functionality onbehalf of a client module.

The term code, as used above, may include software, firmware, and/ormicrocode, and may refer to programs, routines, functions, classes, datastructures, and/or objects. The term shared processor circuitencompasses a single processor circuit that executes some or all codefrom multiple modules. The term group processor circuit encompasses aprocessor circuit that, in combination with additional processorcircuits, executes some or all code from one or more modules. Referencesto multiple processor circuits encompass multiple processor circuits ondiscrete dies, multiple processor circuits on a single die, multiplecores of a single processor circuit, multiple threads of a singleprocessor circuit, or a combination of the above. The term shared memorycircuit encompasses a single memory circuit that stores some or all codefrom multiple modules. The term group memory circuit encompasses amemory circuit that, in combination with additional memories, storessome or all code from one or more modules.

The term memory circuit is a subset of the term computer-readablemedium. The term computer-readable medium, as used herein, does notencompass transitory electrical or electromagnetic signals propagatingthrough a medium (such as on a carrier wave); the term computer-readablemedium may therefore be considered tangible and non-transitory.Non-limiting examples of a non-transitory, tangible computer-readablemedium are nonvolatile memory circuits (such as a flash memory circuit,an erasable programmable read-only memory circuit, or a mask read-onlymemory circuit), volatile memory circuits (such as a static randomaccess memory circuit or a dynamic random access memory circuit),magnetic storage media (such as an analog or digital magnetic tape or ahard disk drive), and optical storage media (such as a CD, a DVD, or aBlu-ray Disc).

The apparatuses and methods described in this application may bepartially or fully implemented by a special purpose computer created byconfiguring a general purpose computer to execute one or more particularfunctions embodied in computer programs. The functional blocks,flowchart components, and other elements described above serve assoftware specifications, which can be translated into the computerprograms by the routine work of a skilled technician or programmer.

The computer programs include processor-executable instructions that arestored on at least one non-transitory, tangible computer-readablemedium. The computer programs may also include or rely on stored data.The computer programs may encompass a basic input/output system (BIOS)that interacts with hardware of the special purpose computer, devicedrivers that interact with particular devices of the special purposecomputer, one or more operating systems, user applications, backgroundservices, background applications, etc.

The computer programs may include: (i) descriptive text to be parsed,such as HTML (hypertext markup language) or XML (extensible markuplanguage), (ii) assembly code, (iii) object code generated from sourcecode by a compiler, (iv) source code for execution by an interpreter,(v) source code for compilation and execution by a just-in-timecompiler, etc. As examples only, source code may be written using syntaxfrom languages including C, C++, C#, Objective C, Haskell, Go, SQL, R,Lisp, Java®, Fortran, Perl, Pascal, Curl, OCaml, Javascript®, HTML5,Ada, ASP (active server pages), PHP, Scala, Eiffel, Smalltalk, Erlang,Ruby, Flash®, Visual Basic®, Lua, and Python®.

None of the elements recited in the claims are intended to be ameans-plus-function element within the meaning of 35 U.S.C. § 112(f)unless an element is expressly recited using the phrase “means for,” orin the case of a method claim using the phrases “operation for” or “stepfor.”

What is claimed is:
 1. A system comprising: an initialization moduleconfigured to obtain patient parameters for a first patient, wherein theinitialization module is configured to select a first plurality ofsettings for an x-ray source based on the patient parameters; an imagemodule configured to obtain (i) a first sample set of one or more imagesof a region-of-interest of the first patient, and (ii) a master sampleset of one or more images, wherein the first sample set of one or moreimages are acquired as a result of the x-ray source operating accordingto the first plurality of settings; an alignment module configured toalign the first sample set of one or more images to the master sampleset of one or more images; a processing module configured to processdata corresponding to a result of the alignment; and a setting moduleconfigured to adjust the first plurality of settings to provide updatedsettings, wherein x-ray dosage associated with the updated settings isless than x-ray dosage associated with the first plurality of settings.2. The system of claim 1, further comprising a quality module configuredto (i) determine quality of the first sample set of one or more images,and (ii) instruct the image module to acquire a second set of one ormore images based on the quality of the first sample set of one or moreimages.
 3. The system of claim 1, wherein the image module is configuredto (i) determine if a minimum sample set is available prior to theprocessing module processing the data, and (ii) if the minimum sampleset is not available, acquire or access a second sample set of one ormore images.
 4. The system of claim 1, wherein the setting module isconfigured to determine updated settings for the x-rays source based on:a size of the first patient; the region-of-interest of the patient;pixel intensity levels of the first sample set of one or more images andmaster sample set of one or more images; and continuity of the firstsample set of one or more images.
 5. The system of claim 1, whereinsetting module is configured to, during an auto-learn mode, (i) adjustthe first plurality of settings to the updated settings, and (ii) prompta surgeon for confirmation of the updated settings; and wherein thesetting module is configured to, during a manual mode, (i) prompt asurgeon of the updated settings without adjusting the first plurality ofsettings, and (ii) adjust the first plurality of settings to the updatedsettings if an input is received indicating confirmation of the updatedsettings.
 6. The system of claim 1, wherein the alignment module isconfigured to (i) rotate and adjust zoom levels of the first sample setof one or more images for alignment with the master sample set of one ormore images, and (ii) verify alignment of the first set of one or moreimages with the master sample set of one or more images.
 7. The systemof claim 1, further comprising a feedback module configured to providefeedback indicating whether one or more the first plurality of settingsfor a procedure are outside (i) one or more respective ranges of typicalsettings used for the procedure, or (ii) one or more respective rangesof recommended settings for the procedure.
 8. The system of claim 1,further comprising a threshold module configured to generate a warningsignal to indicate that one or more of the first plurality of settingsis outside one or more ranges indicating x-ray dosage resulting from useof the first plurality of settings is greater than a predeterminedthreshold.
 9. The system of claim 1, wherein the processing module isconfigured to process pixel data corresponding to the result of thealignment.
 10. A method comprising: obtaining patient parameters for afirst patient; selecting a first plurality of settings for an x-raysource based on the patient parameters; obtaining (i) a first sample setof one or more images of a region-of-interest of the first patient, and(ii) a master sample set of one or more images, wherein the first sampleset of one or more images are acquired as a result of the x-ray sourceoperating according to the first plurality of settings; aligning thefirst sample set of one or more images to the master sample set of oneor more images; processing data corresponding to a result of thealignment; and adjusting the first plurality of settings to provideupdated settings, wherein x-ray dosage associated with the updatedsettings is less than x-ray dosage associated with the first pluralityof settings.
 11. The method of claim 10, further comprising acquiringthe master sample set of one or more images based on a second pluralityof settings of the x-ray source, wherein the second plurality ofsettings is different than the first plurality of settings.
 12. Themethod of claim 10, wherein the master sample set of one or more imagesis obtained prior to the first sample set of one or more images andprior to or during a same procedure as the first sample set of one ormore images.
 13. The method of claim 10, wherein the first sample set ofone or more images are acquired while operating in an auto-learn mode ora manual mode.
 14. The method of claim 10, wherein the first sample setof one or more images are accessed from a memory during a postprocessing mode.
 15. The method of claim 10, further comprising:determining if a minimum sample set is available prior to the processingmodule processing the data; and if the minimum sample set is notavailable, acquiring or access a second sample set of one or moreimages.
 16. The method of claim 15, wherein the second sample set of oneor more images is of the region-of-interest of the first patient or isof a region-of-interest of a second patient.
 17. The method of claim 16,further comprising storing the updated settings as a preset or as anupdated master sample set of one or more images for a second procedure,wherein: the first plurality of settings are used to acquire the firstsample set of one or more images during a first procedure; and thesecond procedure is performed subsequent to the first procedure.
 18. Themethod of claim 10, wherein the patient parameters include parameterscorresponding to the first patient and parameters corresponding to asecond patient.
 19. The method of claim 10, further comprisingdetermining continuity of the first sample set of one or more images.20. The method of claim 10, further comprising processing pixel datacorresponding to a result of the alignment.